SIRT Compared with DEB-TACE for Hepatocellular Carcinoma: a Real-world Study (the SITAR Study)
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ORIGINAL RESEARCH
SIRT Compared with DEB-TACE for Hepatocellular Carcinoma: a Real-world Study (the SITAR Study) Ryan D. Hirsch 1,2 & Chris Mills 3 & Rohit Sawhney 1,2 & Siddharth Sood 4 & Virginia Bird 4 & Gauri Mishra 5 & Anouk Dev 5 & William Kemp 6,7 & John Lubel 6,7 & Stuart K. Roberts 6,7 & Paul Gow 3 & Amanda J. Nicoll 1,2,4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Hepatocellular carcinoma (HCC) is responsible for 1% of deaths worldwide, and the incidence continues to increase. Despite surveillance programs, 70% of HCC patients are not suitable for curative options at diagnosis, and therefore, non-curative treatments are essential to modern clinical practice. There are many novel treatments, though their roles are not well defined. This study aimed to contrast Selective Internal Radiation Therapy (SIRT) and Drug Eluting Bead Transarterial Chemoembolisation (DEB-TACE) to further define their roles. Methods This was a retrospective multicentre cohort study. Factors included for analysis were type of HCC treatment, number of lesions, lesion size, multiple disease severity scores, cirrhosis and vascular invasion. The primary endpoint was transplant-free survival. Results Transplant-free survival was similar between the two cohorts (p = 0.654), despite a variation in median lesion size, SIRT: 54.5 mm, DEB-TACE: 34 mm (p ≤ 0.001). A univariate Cox proportional hazard model utilising treatment modality as the covariate showed no significant difference in survival (DEB-TACE HR 1.4 (95%CI 0.85–2.15 p = 0.207). The size of the largest lesion was the best predictor of 3-year survival (p = 0.035). Lesion size was inversely associated with survival (HR 1.01 (95%CI 1–1.02, p = 0.025)) on multivariate analysis. Conclusion This study is the first to catalogue the experience of using SIRT in HCC in a real-world Australian population. It has demonstrated no difference in survival outcomes between DEB-TACE and SIRT. Further, it has shown SIRT to be a reasonable alternative to DEB-TACE especially in larger lesions and has demonstrated that DEB-TACE has a role in select patients with advanced disease. Keywords Selective internal radiation therapy . Transarterial radiation therapy . Drug eluting bead chemoembolisation . Intra-arterial therapy . Liver cancer . Hepatocellular carcinoma
Lay Summary SIRT is a reasonable alternative to DEB-TACE especially in larger lesions. DEB-TACE has a role in select patients with advanced disease. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12029-020-00502-z) contains supplementary material, which is available to authorized users. * Ryan D. Hirsch [email protected]
4
Gastroenterology and Hepatology, Melbourne Health, Parkville, Victoria, Australia
5 1
Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
Gastroenterology, Monash Health, Clayton, Victoria, Australia
6
2
Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
Gastroenterology, Eas
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